POS1139 GLUCOCORTICOIDS AND BONE DENSITY IN POLYMYALGIA RHEUMATICA, GIANT CELL ARTERITIS, AND OTHER VASCULITIDES – A CROSS-SECTIONAL ANALYSIS OF THE Rh-GIOP COHORT
Authors: A. Palmowski, E. Wiebe, B. Muche, S. Hermann, C. Dejaco, E. Matteson, F. Buttgereit
Journal: Annals of the Rheumatic Diseases (2022)

Background There are only few, inconclusive investigations on bone density and the effects of glucocorticoids (GCs) in polymyalgia rheumatica (PMR) and vasculitides. Objectives To determine whether GCs are associated with bone density in patients with PMR and other vasculitides after adjustment for confounders. Methods The Rh-GIOP cohort study started in 2015 and investigates bone health in patients with rheumatic diseases. In this cross-sectional analysis of baseline visits, we included patients with PMR and vasculitides. Multiple regression was used to model the effect of current and cumulative GC intake on the minimum T-score (mTs; lumbar spine or hip) with adjustment for several confounders such as age, sex, body mass index (BMI), or inflammation (measured by c-reactive protein (CRP)). GCs were modelled both as continuous and as categorical predictors in separate models. Several sensitivity analyses were performed. Patients with early disease (&lt;3 months) were excluded from inferential analyses as were patients with very high GC dosages (&gt;100mg/d prednisolone equivalent). Multiple imputation by chained equations was used for missing data (about 5%). Results 198 patients (mean age 68 ± 11 years; 68% females) with a mean disease duration of 5.3 ± 6.3 years were included. The most common rheumatic disease was PMR (36%), followed by giant cell arteritis (26%) and granulomatosis with polyangiitis (17%). 87% were currently taking GCs, 88% received vitamin D supplements, 7% had a deficiency. Osteoporosis (OP) diagnosed by DXA (T-score ≤ -2.5) was present in 20% of patients. Mean CRP was 13.2 ± 26.1 mg/l. Scatter- and boxplots of mTs and GC intake are presented in Figure 1 A-D . GC dose was not associated with mTs in any model (current intake: β (continuous model) = -0.01, 97.5% CI -0.02 to 0.01; p (all models) ≥ 0.49; cumulative intake: β (continuous model) = 0.01, 97.5% CI -0.04 to 0.07; p (all models) ≥ 0.35). Inflammation (measured by CRP) was also not associated with mTs ( p (all models) ≥ 0.56), and no significant interaction between CRP and GC intake was found ( p for interaction(all models) ≥ 0.32). Lower body mass index ( p (all models) ≤ 0.01), history of vertebral fractures ( p (all models) ≤ 0.02), and proton-pump inhibitor intake ( p (all models) ≤ 0.04) were associated with bone loss in all models. The results were similar with femoral neck and lumbar spine T-scores as dependent variables, and after excluding patients with PMR. Figure 1. Conclusion In this cohort of PMR and vasculitides, the prevalence of OP was similar to the overall elderly German population. 1 Vitamin D supplementation was common while deficiencies were surprisingly rare – In population-based studies, about 32% of Germans are estimated to have a vitamin D deficit. 2 We found no association between current or cumulative GC intake, inflammation, and bone density. Proton-pump inhibitor intake and BMI as modifiable risk factors were associated with mTs. These findings need confirmation from longitudinal analyses of our and other cohorts. References [1]Fuchs J, Scheidt-Nave C, Kuhnert R. 12-Monats-Prävalenz von Osteoporose in Deutschland: Robert Koch-Institut, Epidemiologie und Gesundheitsberichterstattung, 2017. [2]Rabenberg M, Mensink G. Vitamin-D-Status in Deutschland: Robert Koch-Institut, Epidemiologie und Gesundheitsberichterstattung, 2016. Acknowledgements Funding Rh-GIOP is supported by a joint funding from Amgen, Biogen, BMS, Chugai, Generic Assays, GSK, Hexal, Horizon Therapeutics, Lilly, Medac, Mundipharma, Novartis, Pfizer, Roche and Sanofi. Disclosure of Interests Andriko Palmowski: None declared, Edgar Wiebe Grant/research support from: Travel expenses and consultancy fees from Medac, Burkhard Muche Speakers bureau: Speaker fees of one of these: Amgen, Gilead, Galapagos, UCB and Stadapharm, Consultant of: Consultancy fees of one of these: Amgen, Gilead, Galapagos, UCB and Stadapharm, Grant/research support from: Conference expenses of one of these: Amgen, Gilead, Galapagos, UCB and Stadapharm, Sandra Hermann Speakers bureau: Lecture fees from AbbVie, Christian Dejaco Speakers bureau: Speaker fees from one of these: Abbvie, Eli Lilly, Janssen, Novartis, Pfizer, Roche, Galapagos and Sanofi, Consultant of: Consulting fees from one of these: Abbvie, Eli Lilly, Janssen, Novartis, Pfizer, Roche, Galapagos and Sanofi, Eric Matteson Speakers bureau: editorial and contributor, UpToDate, Consultant of: editorial and contributor, UpToDate, Employee of: editorial and contributor, UpToDate, Frank Buttgereit Speakers bureau: Abbvie, AstraZeneca, Grünenthal, Pfizer, and Roche, Consultant of: Abbvie, AstraZeneca, Grünenthal, Pfizer, and Roche, Grant/research support from: Travel expenses: Abbvie, AstraZeneca, Grünenthal, Pfizer, and Roche. Grant support: Abbvie, Pfizer and Roche